Definition of emergency specific to mental health


or substance abuse

FL | FLMH | IA | MD | MABH | MO | NEBH | TX | WI


 


FL

"21.  Emergency (behavioral health) - An emergency (behavioral health) is defined as an emergent situation in which the member is in need of assessment and treatment in a safe and therapeutic setting, is a danger to himself or others, exhibits acute onset of psychosis, exhibits severe thought disorganization, or exhibits significant clinical deterioration in a chronic behavioral condition rendering the member unmanageable and unable to cooperate in treatment."  Florida Contract, page 165.

"2.  Outpatient Mental Health Hospital Services/Emergency Mental Health Services
a. Emergency behavioral health services are as follows:
Those services required to meet the needs of an individual who is in need of assessment and treatment in a safe and therapeutic setting and who meets at least one of the following criteria: is a danger to himself or others, exhibits acute onset of psychosis, exhibits severe thought disorganization, or exhibits significant clinical deterioration in a chronic behavioral condition rendering the member unmanageable and unable to cooperate in treatment..."  Florida Contract, page 168.

FLMH

"C.   Emergency Mental Health Services - Those services required to meet the needs of an individual who is experiencing an acute crisis, resulting from a mental illness, which is at a level of severity that would meet the requirements for involuntary hospitalization pursuant to section 394.467, Florida Statutes, and who, in the absence of a suitable alternative, would require hospitalization."  Florida Mental Health Contract, page 15.

"2.3  Medicaid Service Requirements...
B.  Outpatient Hospital Services/Emergency Medical and Mental Health Services...
2. ... Emergency mental health services are those services required to meet the needs of an individual who is experiencing an acute crisis which is at a level of severity that would meet the requirements for involuntary hospitalization pursuant to the Baker Act, section 394. 467, Florida Statutes, and who, in the absence of a suitable alternative, would require hospitalization."  Florida Mental Health Contract, page 23.

IA

"1.3  Definitions...
- Emergency Mental Health Services - those clinical, rehabilitative, or supportive  mental health services provided for mental health conditions or disorders which, if not immediately diagnosed and treated, would result in risk of danger to an Enrollee's self or others or in the likelihood of significant damage or disruption to an Enrollee's  life or mental health status."  Iowa Contract, pages 6-7.

MD

"(100)  'Mental health emergency' means, in the context of COMAR 10.09.70, that an individual presents a danger to the life or safety of the individual or others."  Maryland COMAR 10.09.62.01.

MABH

"I. DMA Covered Services
A. Inpatient Services - shall mean twenty-four hour services which provide medical intervention for mental health or substance abuse diagnoses, or both...
  2. Inpatient Mental Health Services - shall mean hospital services to stabilize an acute psychiatric condition which: 1) has a relatively sudden onset; 2) has a short, severe course; 3) poses a significant danger to self or other; and/or 4) has resulted in marked psychosocial dysfunction and/or grave mental disability."  Massachusetts MH/SAP Contract, Appendix C, page 1.

MO

"23)  Emergency medical services.  Emergency medical services are defined as those health care items and services furnished or required to evaluate or stabilize a sudden and unforeseen situation or occurrence or a sudden onset of a medical or behavioral condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the failure to provide immediate medical attention could reasonably be expected by a prudent lay person, possessing average knowledge of health and medicine, to result in:
*  placing the patient's health (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or
* serious impairment if bodily functions; or
* serious dysfunction of any bodily organ or part; or
* serious harm to a member or others due to an alcohol or drug abuse emergency; or
*  injury to self or bodily harm to others; or
* with respect to a pregnant woman who is having contractions: (1) that there is inadequate time to effect a safe transfer of another hospital before delivery or in (2) that transfer may pose a threat to the health or safety of the woman or the unborn."  Missouri RFP, page 10.

NEBH

"4.1  Applicable Definitions: The following definitions apply under this contract: ...
4.1.12  The term ‘Emergency Medical Condition’ means a medical or behavioral health condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in:
(a)  Placing the health of the person afflicted with such condition in serious jeopardy or, in the case of a behavioral condition, placing the health of such person or others in serious jeopardy..."  Nebraska Behavioral Health Contract, pages 6-7.

TX

"Emergency behavioral health condition means any condition, without regard to the nature or cause of the condition, which in the opinion of a prudent layperson possessing an average knowledge of health and medicine requires immediate intervention and/or medical attention without which Members would present an immediate danger to themselves or others or which renders Members incapable of controlling, knowing or understanding the consequences of their actions."  Texas Contract, page 6.

WI

"The term 'emergency medical condition' means -
A. a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: ...
C.  a psychiatric emergency involving a significant risk of serious harm to oneself or others.
D.  a substance abuse emergency exists if there is significant risk of serious harm to an enrollee or others, or there is likelihood of return to substance abuse without immediate treatment…"  Wisconsin Contract, pages 2-3."